Government Programs Care Manager III

Job Summary

This position is responsible to provide care coordination to members via telephonic and/or field-based care management to inform and educate them on health care programs to address their personal health needs, engaging the member in discussion of adherence to personal health goals, responding to inquiries from members, and supporting clinical operations with provider and member activities. This position will be required to complete member telephonic and/or field-based health screenings, comprehensive health assessments and care planning duties which may require visits to members' homes and/or facilities to support complex and specialty populations.

Required Job Qualifications:

• Registered Nurse (RN) with 2 years direct clinical care to the consumer in a clinical setting or, unrestricted Licensed Professional Counselor (LPC, TX), or Licensed Master Social Worker (LMSW, TX), Licensed Clinical Professional Counselor (LCPC, IL) or Licensed Clinical Social Worker (LCSW, IL & NM) Licensed Marriage and Family Therapist (LMFT, IL & NM), Licensed Professional Clinical Counselor (LPCC, NM), Licensed Independent Social Worker (LISW, NM), or Licensed Mental Health Counselor {LMHC, NM) with 2 years of clinical practice experience.
• Current, valid, unrestricted license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, you must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire.
• Plus 3 years' wellness or managed care experience presenting clinical issues with members/physicians.
• Knowledge of the health and wellness marketplace and employer trends.
• Verbal and written communication skills including discussing medical needs with members and interfacing with internal staff/management and external vendors and community resources.
• Analytical experience including medical data analysis.
• PC proficiency to include Word, Excel, and PowerPoint, database experience and Web based applications.
• Current unrestricted driver's license, transportation and applicable insurance.
• Ability and willingness to travel within assigned territory.

Additional State Specific Requirements

• Illinois Only
  • High-needs children:
    • Bachelor's degree in nursing, social sciences, social work, or related field
    • (1) year of supervised clinical experience in a human- services field

Qualifications of Certain Care Coordinators

Persons who are Elderly Waiver Care Coordinators must meet one (1) of the four (4) following requirements: Registered Nurse (RN) licensed in Illinois Bachelor's degree in nursing, social sciences, social work, or related field Licensed Practical Nurse (LPN) with one (1) year experience in conducting comprehensive assessments and provision of formal service for the elderly and/or authorizing service provisions, One (1) year of satisfactory program experience, which is defined as assessment, provision, and/or authorization of formal services for the elderly, may replace one year of college education, at least four (4) years of experience replacing baccalaureate degree Persons with Disabilities Waiver Care Coordinators must meet one (1) of the nine (9) following requirements: Registered Nurse (RN) Licensed Clinical Social Worker (LCSW) Licensed Marriage and Family Therapist (LMFT) Licensed Clinical Professional Counselor (LCPC) Licensed Professional Counselor (LPC) Doctor of Philosophy (PhD) Doctorate in Psychology (PsyD) Bachelor's or master's Degree prepared in human services related field Licensed Practical Nurse (LPN) Persons with Brain Injury Waiver Care Coordinators must meet one (1) of the seven (7) following requirements: Registered Nurse (RN) licensed in Illinois Certified or Licensed social worker Unlicensed social worker: minimum of bachelor's degree in social work, social sciences, or counseling Vocational specialist: certified Rehabilitation counselor or at least three (3) years' experience working with people with disabilities Licensed Clinical Professional Counselor (LCPC) Licensed Professional Counselor (LPC) Certified Case Manager (CCM) Persons with HIV/AIDS Waiver Care Coordinators must meet one (1) of the three (3) following requirements: A Registered Nurse (RN) licensed in Illinois and a bachelor's degree in nursing, social work, social sciences, or counseling or one (1) years of case management experience. A Social worker with a bachelor's degree in either social work, social sciences, or counseling (A Bachelor of Social Work or a Master of Social Work from a school accredited by any organization nationally recognized for the accreditation of schools of social work is preferred). Individual with a bachelor's degree in a human services field (including, but not limited to sociology, special education, rehabilitation counseling) with a minimum of one (1) years of case management experience. In addition, it is mandatory that the Care Coordinator for Enrollees within the Persons with HIV/AIDS Waiver have experience in working with racial and ethnic minorities, as well as one or more of the following: Domestic Abuse The lesbian, gay, bisexual, transgender, queer (LBGTQ+) community Persons living with HIV/AIDS, and Persons with substance use disorders

Preferred Job Qualifications:

• 3 years direct clinical experience.
• Patient education experience.
• Condition Management experience.
• Bilingual in English and Spanish.
• Experience in managing complex or catastrophic cases.
• Certification in Case Management, Training, Project Management or nationally recognized health care certification.
• Government Programs experience
• Population Management

Telecommute: This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$26.90 - $59.35

Exact compensation may vary based on skills, experience, and location.

Health Care Service Corporation